Injury risk increased in patients with serious mental illnesses

By Mark Cowen

People with serious mental illnesses are significantly more likely to experience injuries than the general population, US study results show.

In a 7-year study of 6234 Medicaid recipients with schizophrenia, bipolar disorder, or other serious mental illnesses, the researchers found that the incidence of injuries requiring a visit to the emergency department or hospital admittance was 80% higher than in the general population.

They also found that the risk for fatal injuries was 4.7 times greater in people with serious mental illnesses compared with the general population.

"Primary care and mental health clinicians should consider counselling persons with serious mental illness and their care givers on risk of injury," comment Gail Daumit (Johns Hopkins Medical Institutions, Baltimore, Maryland) and team.

They add: "Counselling should include strategies recommended by clinical guidelines, including use of bicycle and motorcycle helmets, safe firearm storage practices, and fall prevention strategies… In addition, clinicians should evaluate and address side effects from psychotropic medications, such as dizziness, which may lead to unintentional injury."

Overall, 43% of the study population had at least one primary International Classification of Diseases-9 diagnosis of injury from an inpatient hospitalization or emergency department visit between 1994 and 2001. Of these patients, 42% had one injury, 23% had two injuries, 25% had three to five injuries, and 10% had six or more injuries during the study period.

Systemic injuries due to poisoning (10.4%) were the most common injuries, followed by open wounds to the head/face (8.9%), superficial injuries (8.6%), fractures (8.5%), and sprains of the extremities (8.4%).

Of the 7298 injuries experienced by the cohort, 117 (2%) resulted in death.

The researchers note that substance abuse, which is common among patients with serious mental illnesses, significantly increased the risk for injury and injury-related death, at hazard ratios of 1.87 and 4.76, respectively.

Writing in Injury Prevention, Daumit et al conclude: "Persons with serious mental illness are at heightened risk for injuries compared with the overall US population."

They add: "Additional research is needed to better understand the mechanisms driving heightened risk of injury among persons with serious mental illness and to develop strategies for injury prevention among this population."

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